The U.S. Centers for Disease Control and Prevention (CDC) recently reaffirmed its recommendation that sexually active gay and bisexual men should undergo at least annual HIV screening, according to a report in the August 11 edition of the CDC's Morbidity and Mortality Weekly Report. However, some local providers advise more frequent HIV and sexually transmitted infection tests.

In 2006 the CDC recommended that everyone between the ages of 13 and 64 should be screened for HIV at least once, and that those at higher risk for infection -- including sexually active men who have sex with men -- should be rescreened at least annually.

A 2013 review by the U.S. Preventive Services Task Force did not find enough evidence to specify a particular HIV testing interval, but concluded that annual screening for gay men was a "reasonable approach."

However, a growing number of providers who see gay and bi men are offering more frequent HIV screening, typically every 3 or 6 months.

In part, this is related to increased use of pre-exposure prophylaxis, or PrEP. CDC's 2014 PrEP guidelines call for HIV testing every 3 months while taking Truvada (tenofovir DF/emtricitabine) for HIV prevention. This is important because Truvada alone is not enough to treat HIV if someone does become infected.

Providers increasingly recommend screening for other sexually transmitted infections (STIs) such as gonorrhea and syphilis, as well as HIV. Frequent testing allows STIs to be detected and treated early, thereby preventing disease progression and onward transmission.

In light of changing practice, a CDC working group performed an updated systematic review of relevant medical studies and held 4 expert consultations to determine if there is enough evidence to change the 2006 recommendation of annual HIV screening.

The working group, made up of epidemiologists, clinicians, behavioral scientists, health policy experts, and health economists, reviewed more than 100 studies comparing the benefits of annual versus more frequent screening for men who have sex with men.

The group concluded that "the evidence, programmatic experience, and expert opinions are insufficient to warrant changing the current recommendation" from at least annual screening to more frequent testing.

However, the experts agreed that mathematical models suggest that more frequent screening may be beneficial, as prompt HIV treatment also plays a role in prevention. Research conclusively shows that HIV-positive people on antiretroviral therapy with an undetectable viral load do not transmit the virus through sex.

"CDC continues to recommend that clinicians screen asymptomatic sexually active men who have sex with men [MSM] at least annually," the authors wrote. "Each clinician can consider the benefits of offering more frequent screening (e.g., once every 3 or 6 months) to individual MSM at increased risk for acquiring HIV infection, weighing their patients’ individual risk factors, local HIV epidemiology, and local testing policies."

"For MSM who are prescribed pre-exposure prophylaxis, HIV testing every 3 months and immediate testing whenever signs and symptoms of acute HIV infection are reported is indicated," they continued. "MSM who experience a specific high-risk sexual exposure or have symptoms of recent HIV infection should seek immediate HIV testing, and clinicians should be alert for the symptoms of acute HIV infection and provide appropriate diagnostic testing."

Locals Disagree

Two of the major care providers for gay men in San Francisco are among those that recommend more frequent HIV screening.

"The San Francisco Department of Public Health recommends quarterly [STI] screening for HIV-positive and HIV-negative sexually active men and trans individuals who have sex with men, and quarterly HIV screening for those who are HIV negative," said City Clinic medical director Stephanie Cohen.

"This approach to HIV screening has been a critical component of our HIV prevention efforts, and is one of the reasons why approximately 93% of people living with HIV in San Francisco know their status," she continued. "Early identification coupled with rapid linkage to care optimizes individual health and reduces the time to virologic suppression, which decreases the chance for ongoing transmission."

"At Magnet, we recommend that everyone get an HIV test once in their life and people who are more frequently sexually active with multiple partners get tested every 3 months along with routine gonorrhea, chlamydia, and syphilis testing," said Magnet director of nursing Pierre-Cédric Crouch. "Frequent HIV testing identifies people with new HIV infections earlier, allowing them to engage in their health."